This application proposes a program of research, development, and evaluation with respect to the design, collection, and use of consumers'assessments of health care for informing health care choices and quality improvement. The specific goals of the program are to: 1) develop and test ways that organizations can use CAHPS data for quality improvement purposes, with an emphasis on using data from the CAHPS clinician and group instrument, 2) conduct research on and develop strategies for reporting CAHPS results to consumers, patients, and providers and other audiences to facilitate plan choice, public accountability, and quality improvement. This will include developing and testing resources that can be used by report developers to design useful and usable reports, 3) develop CAHPS surveys, such as a survey for residents of assisted living facilities, and maintain and refine the current CAHPS surveys, and 4) disseminate and promote the use of CAHPS products. The methods to be used will include focus groups, cognitive interviewing, interviewing of expert informants, and field tests of draft surveys. Standard psychometric statistical techniques will be used to assess quantitative data. The applicants are a consortium of experts in consumer survey design, report development, experimental assessment of consumer perceptions and medical care choice behavior, quality improvement, evaluation research, and community-based dissemination methods from the School of Public Health, Yale University, Massachusetts General Hospital/Partners Healthcare System and the Harvard Medical School, the Center for Survey Research at the University of Massachusetts, the Center for Measuring Rehabilitation Outcomes at Boston University, and several nationally known independent researchers and consultants. This consortium proposes maintaining continuity in the CAHPS development process by continuing critical activities and well established collaborations from the CAHPS I and CAHPS II projects, while strengthening the team to bring new skills, perspectives and expertise to the project. The team has maintained close contact with collaborating demonstration sites from earlier CAHPS projects and has established new relationships with public and private organizations that share an interest in refining and assessing CAHPS products for improved decision making and quality improvement.